Candida albicans Endocarditis: Ultrastructural Studies of Vegetation Formation

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Candida albicans endocarditis was established in rabbits after transaortic catherization. Within 30 to 90 min after infection, C. albicans was observed by scanning electron microscopy on the valve surface. The organisms were predominantly associated with host deposits of erythrocytes, phagocytes, platelets, and fibrinous-appearing material, which collectively appeared on the valve surface in response to trauma. Within 48 h after infection, vegetations composed of these same host components were observed on the heart valves, although Candida cells were not demonstrable on the valve or vegetation surface. When the vegetations were examined by transmission electron microscopy, Candida blastospores were only observed within phagocytic cells (predominantly monocytes) enmeshed within the vegetation matrix. Many of the intracellular organisms were undergoing degradation, as evidenced by a reduction in electron density of the cell wall. Other fungi had highly electron-dense cell walls and germ tubes. Phagocytic cells containing germinating Candida were highly vacuolated and were observed at various stages of cell lysis. After 7 days of infection, the vegetation contained a dense meshwork of fibrin and Candida pseudohyphae with 108 to 109 colony-forming units/g of vegetation. The mature vegetation was devoid of phagocytic cells and continued to grow until the death of the animal.

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